Sleep apnea is quite common after stroke and associated with poor functional outcomes. Research studies have determined that over half (50%–70%) of stroke survivors have sleep apnea (Kotzian et al., 2012). Sleep-related breathing disturbances and sleep-wake disturbances are often neglected in stroke patients. There are two ways of determining if a person has sleep apnea — 1) Subjective evaluation of symptoms by the health care team (which could include the Berlin questionnaire) and 2) Sleep study that includes a polysonogram.
A recent study highly recommended sleep studies for stroke patients because stroke survivors with untreated sleep apnea have poorer functional outcomes.
A Sleep Study
A sleep study is the most accurate test for diagnosing sleep apnea. It records what happens with your breathing while you sleep. There are different kinds of sleep studies. If your doctor suspects you have sleep apnea, he or she may recommend a polysomnogram or a home-based portable monitor.
Most often sleep studies are done at sleep centers or sleep labs. In some cases, doctors will suggest using a portable sleep monitor at home because it is cheaper.
Prevent stroke by treating sleep apnea?
If you have sleep apnea, you may be at higher risk of stroke. A 2010 study of provides pretty compelling evidence that if you have untreated moderate to severe sleep apnea, you have 3 times the risk of stroke (Redline et al., 2010).
Ask your doctor to evaluate if you have sleep apnea.
Redline et al., (2010). Obstructive Sleep Apnea–Hypopnea and Incident Stroke The Sleep Heart Health Study. American Journal of Respiratory Critical Care Medicine, 182; 269–277.
The Berlin Questionaire
Kotzian ST; Stanek JK; Pinter MM; Grossmann W; Saletu MT (2012). Subjective evaluation of sleep apnea is not sufficient in stroke rehabilitation. Topics In Stroke Rehabilitation Vol. 19 (1), pp. 45-53.
Objective: Sleep apnea (SA) is common in stroke patients and is associated with poor functional outcome. Therefore, we studied the clinical value of the Berlin Questionnaire (BQ), a subjective screening method to detect stroke patients with SA in a neurorehabilitation care unit, and compared it with respirographic sleep studies. Another aim was to explore the association of SA with functional status in the subacute phase after stroke.
Methods: Sixty-eight stroke patients were subjected to respirographic sleep studies to determine their apnea-hypopnea index (AHI). Subjective evaluation was performed by means of the BQ. Functional outcome was assessed by the Barthel Index (BI). Sensitivity and specificity of the BQ for detecting SA in stroke patients were calculated.
Results: Respirographic sleep studies showed a high prevalence of moderate and severe sleep apnea in 56% of stroke patients. Sensitivity and specificity of the BQ for SA (AHI ≯ 15) were 0.69 and 0.15, respectively. The area under the receiver operating characteristics (ROC) curve for detection of SA was 0.58. The AHI correlated significantly with the BI (r = -0.57, P ≤ .001).
Conclusion: As the BQ demonstrated low diagnostic utility in stroke rehabilitation, screening for SA should not be based solely on clinical interviews. SA is linked to poor functional status in the subacute phase post stroke.
Adapted from: Table 2 from Netzer, et al., 1999. (Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999 Oct 5;131(7):485-91).
The questionnaire consists of 3 categories related to the risk of having sleep apnea. Patients can be classified into High Risk or Low Risk based on their responses to the individual items and their overall scores in the symptom categories.
The Sleep Heart Health Study
Susan Redline, Gayane Yenokyan, Daniel J. Gottlieb, Eyal Shahar, George T. O’Connor, Helaine E. Resnick, Marie Diener-West, Mark H. Sanders, Philip A. Wolf, Estella M. Geraghty, Tauqeer Ali, Michael Lebowitz, and Naresh M. Punjabi
Scientific Knowledge on the Subject
Obstructive sleep apnea is a common health problem and is frequently associated with cardiovascular morbidity. Prior studies have not addressed the risk of stroke attributable to sleep apnea in the general population.
What This Study Adds to the Field
This study addresses whether sleep apnea is associated with an increased risk of ischemic stroke in men and women recruited from the community. This study provides compelling evidence, based on 8 years of prospective data from a large, geographically diverse community-based cohort of middle-aged and older adults, that modest to severe levels of sleep apnea are associated with an approximately threefold increase risk of ischemic stroke in men.
Male Sexual Disorders Following Stroke: An Overview
Rocco Salvatore Calabro`, Giuseppe Gervasi, and Placido Bramanti
Istituto di Ricovero e Cura a Carattere Scientifico, Centro Neurolesi “Bonino-Pulejo,” Messina, Italy
ABSTRACT
Stroke is one of the leading causes of death and disability throughout the world. Although physical and cognitive impairments after stroke have been well studied, little information is known about one of the crucial aspect of the quality of life of stroke patients, namely, sexual functioning and satisfaction. Post stroke sexual dysfunctions seem to be very common since in men affected by stroke, a decline in libido and poor or tailed erection and ejaculation are frequently observed. Sexual disorders after stroke are thought to be due to multiple etiologies, including both organic (i.e., lesion localization, premorbid medical conditions, and medications) and psychosocial (i.e., fear of recurrences, loss of self-esteem, role changes, anxiety, and depression). Thus, exploration in sexual dysfunctions and sexual counselling by trained professionals should be a part of stroke rehabilitation. The aim of this review is to evaluate the burden of stroke on sexual function taking into account the complex interaction between neurological, psychological, and relational factors.
Aphasia (/əˈfeɪʒə/ or /əˈfeɪziə/, from ancient Greek ἀφασία (ἄφατος, ἀ- + φημί), "speechlessness") is an impairment of language ability. This class of language disorder ranges from having difficulty remembering words to being completely unable to speak, read, or write.
InteRACT - Intensive Residential Aphasia Communication Therapy
InteRACT is an intensive summer speech and language therapy program for adults with aphasia.
InteRACT is based on the philosophy that individuals with aphasia should be afforded opportunities to maximize their communication potential with the goal of enhanced life participation.
InteRACT is an intensive month long summer residential program providing over 100 hours of speech and language therapy, for adults with aphasia. The program also provides group physiotherapy, Recreation Therapy and training for communication partners. InteRACT, which was launched in 2002 is unique in Canada. It has participants each year from across North America and also has had participants from Europe and Japan. The program is run through the Dalhousie University School of Human Communication Disorders, Halifax, Canada.
The program dates for 2012 are: February 29 - March 30 Spring Session: May 9 - June 8
Summer Session: June 27 - July 27
Enrollment is limited to 6-8 participants per session. Eligible candidates are admitted until spaces are filled. Late applicants will be placed on a "wait list"
Dalhousie University Speech Program Attracts Brain Injury Patients from Around Globe
by The Chronicle Herald News
Dean -->> Like a game of Scrabble, lettered tiles are placed on the table. Make the word, she’s urged. And Joyce Dean unscrambles: Y-O-U. Linda -->> “What does it say?” asks Linda Wozniak, intently watching the 70-year-old woman sitting beside her. Dean -->> And Dean tries. The sounds come haltingly, scrambled, just like those letters were. Linda -->> “Watch my smile,” says Wozniak, enunciating the word, slowly, carefully. Dean -->> “You,” Dean repeats, faster. Linda -->> Unmistakeable. “You.” And then it’s on to four-letter words. Dean -->> K-I-S-S, Dean unscrambles quickly. “Kiss,” she says, without hesitation. And sitting behind her, husband David beams ...
Supporting and enhancing communication abilities and quality of life for adults with aphasia since 1987
The Dalhousie Aphasia Clinic is run through the School of Human Communication Disorders. The Clinic offers a variety of programs for adults with aphasia.
Aphasia Communication Group - a weekly "aerobics for the brain" session which targets speaking, reading, writing, problem solving and conversational skills.
InteRACT - an intensive month long summer residential program providing over 100 hours of speech and language therapy.
Aphasia Book Club - a weekly session highlighting reading and verbal skills in a small group.
An assessment process determines whether a program is "right" for an individual. To schedule an appointment or to find out more about our programs - please contact us!
Dalhousie Aphasia Clinic
School of Human Communication Disorders
1256 Barrington Street, 6th Floor
Halifax, NS B3J 1Y6
Article written by Marty Booher, The Chronicle Herald
November 24, 2011
On Jan. 8, 2011, a gunman, at close range, aimed his weapon at Gabrielle Giffords’ head and pulled the trigger. In that instant, the U.S. Congresswoman from Arizona was launched on a journey parallel to the one my husband began 10 months earlier. It’s a journey that many wounded soldiers, accident survivors and stroke survivors share — not only to regain use of the paralyzed right side of the body, but to regain language abilities.
After nine months of intensive therapy, Giffords spoke in public for the first time in an interview last week with Diane Sawyer. Although her ability to speak is still severely impaired, she has made remarkable progress.
My husband’s journey started in Arizona, too, but did not begin in such a public or dramatic manner. As with thousands of other people, a large stroke left him with disabilities similar to Giffords’. For the 1.1 million people in North America living with aphasia (an impairment of language abilities, including speaking, reading and writing), the struggle to regain those abilities is long and difficult — and almost always without access to the intensive therapy Giffords has received.
Unlike Giffords’ journey that took her to Texas for intensive therapy, our journey led us to InteRACT, Halifax, Nova Scotia.
Research indicates the best treatment for aphasia is intensive therapy and, although Scottsdale, Arizona, has some of the best medical care in the world, intensive therapy was not available anywhere west of Chicago. From my research and discussions with our rehabilitation doctor, I was convinced intensive therapy provided the best chance for recovery, despite the sacrifices we might have to make. After researching programs in Chicago, Michigan and Halifax, I chose the program in Chicago for 2010. The results were very promising; and in 2011, we decided to try another program to expand my husband’s skills.
Nova Scotia seems like an unlikely place for a person from Arizona to look for treatment, but based on a recommendation, we travelled to Halifax for the InteRACT program at Dalhousie University in July. The progress made during the program was huge; our lives have been changed in a dramatic way because of InteRACT. It was the best possible treatment for my husband’s aphasia.
The quality and intensity of the InteRACT program helped my husband make a huge leap forward in his recovery. He is now able to read simple sentences aloud and read novels for pleasure, and has begun to use words to convey ideas. I am confident he will recover much of what he lost with the stroke.
Dalhousie has one of the best-kept secrets on the continent for people living with aphasia. The program structure, the organization and the emphasis on "getting back to life" all provide supports for positive outcomes.
On our journey, we’ve also learned therapy is a personal service and results are different with each therapist. There are only a few world-class therapists and Halifax is privileged to have several of them.
There is something different about the Canadian speech therapists we encountered. Perhaps the universities in Canada do a better job of preparing them, but we felt that the therapists and interns involved in the program were superior to others we’ve encountered. Intensive aphasia therapy at InteRACT was an investment in our future and it is paying big dividends. I can’t think of a better way to invest in our lives right now.
We’ve met some of the world’s best people through this journey and I’m grateful that we live in a time when resources like InteRACT are available. I wonder, though, how many Canadians with aphasia are unaware of this program which has seen people come from across the globe. We travelled more than 3,000 miles and had to use our passports to get to the program that met our needs.
We will be back in July 2012.
Who knows? Perhaps Giffords’ journey will intersect with our journey in Halifax.
Marty Booher lives in Scottsdale, Ariz.
Inside Aphaisa - Comments & YouTube Parts 1, 2, and 3.
I have recently gotten slightly better. I will suggest practising tongue twisters to you, that helped me all lot. I came out to my family that I have trouble communicating with other people, they helped me all lot. You should tell yours too and just start conversation. I cannot explain to you how helpful this was to me. Even if you have a pet just keep speaking to it, I still forget words but I have better communication skills to help me disguise it or work around it. I hope this helped. -- MrNinjaSpartan
I am 17 and have this. It is extremely distressing. I think this program makes one mistake that this disorder mostly the elderly have it, anybody at any age can get it. -- sena929
Whoever thinks that the effects of aphasia is humorous is an extremely disturbed human being... if whoever it is is even considered human. -- lucyba
Inside Aphaisa : Part 1 of 3
Inside Aphaisa : Part 2 of 3
Inside Aphaisa : Part 3 of 3
Two Other Examples of Aphasia
Broca's Aphasia
If the patient was given a written text to describe, I would still expect the patient to struggle with producing language. Of course, this depends on the extent of the lesion.
In cognitive neuropsychology literature, there is a transcript depicting a patient trying to describe the follow picture: a mother is washing dishes while in the background, two children use a stool to steal something out of a jar.
I think this may be that patient (if not, then the content of the video suggests a similar task, if not the same one, may have been given to others with Brocas aphasia).
(SSTattler: By Students -- the first introduction is a bit weird but students are students!)
Two different Broadcasters on TV have suddenly have Wernicke's Aphasia.
In YouTube at 3:12 WISC TV Studio (by unknown name)
In YouTube at 3:45 CBS-2 by Serene Branson
Wernicke's aphasia affects the comprehension of language, not just speech. She can understand the actual words being spoken to her, but not the meaning behind them. Broca patients will say the right words, but they won't have any sentence structure around the words, and generally slowly with bad rhythm. Wernicke's patients usually speak with normal structure, rhythm and tone, but use made-up or wrong words.
The lady, at 4:00, I think she is having trouble comprehending the meaning of the questions, especially after around 5:00... she's just repeating the words instead of responding to them. Eventually it seems she finds some sort of meaning in them, but it's not clear or immediate.
* For Better and For Worse" is a serious topic of stroke but with a very nice cartoons. It is all about Grandpa Jim had a stroke and 88 further cartoon "strips" that happened to Grandpa Jim. (See as well the author Lynn Johnston).
** I tried to get low or free price at the people http://www.UniversalUclick.com/ for the images for the cartoons. It was too high for Stroke Survivors Tattler i.e. we are not a regular newspaper and our budget is very low. Fortunately, you will have to do only 1-click more to see the cartoon image, it is legit and it is free using GoComics.com and Dilbert.com.
*** Changed from "Pickles" to "Betty" -- "Betty" is a excellent cartoon and Gary Delainey & Gerry Rasmussen are authors/artists/cartoon-strips and they live in Edmonton.
A woman brought a very limp duck into a veterinary surgeon. As she laid her pet on the table, the vet pulled out his stethoscope and listened to the bird's chest.
After a moment or two, the vet shook his head and sadly said, "I'm sorry, your duck, Cuddles, has passed away."
The distressed woman wailed, "Are you sure?" "Yes, I am sure. Your duck is dead," replied the vet..
"How can you be so sure?" she protested. "I mean you haven't done any testing on him or anything. He might just be in a coma or something."
The vet rolled his eyes, turned around and left the room. He returned a few minutes later with a black Labrador Retriever. As the duck's owner looked on in amazement, the dog stood on his hind legs, put his front paws on the examination table and sniffed the duck from top to bottom. He then looked up at the vet with sad eyes and shook his head.
The vet patted the dog on the head and took it out of the room. A few minutes later he returned with a cat. The cat jumped on the table and also delicately sniffed the bird from head to foot. The cat sat back on its haunches, shook its head, meowed softly and strolled out of the room.
The vet looked at the woman and said, "I'm sorry, but as I said, this is most definitely, 100% certifiably, a dead duck."
The vet turned to his computer terminal, hit a few keys and produced a bill, which he handed to the woman... The duck's owner, still in shock, took the bill. "$150!" she cried, "$150 just to tell me my duck is dead!"
The vet shrugged, "I'm sorry. If you had just taken my word for it, the bill would have been $20, but with the Lab Report and the Cat Scan, it's now $150."
... and ...
Fly in the Toilet
When my friend's hubby went to the men's room in the Schiphol Airport located in Amsterdam, he saw a fly and did his best to 'wash' it down the drain... but failed. He figured the fly had super glue foot pads !!!
This week I am writing about things that could help us on the physical side of us. Possibly you have much better outlets than I do but everyone is different and enjoys diverse things. After I got home from the hospital, a little more than 5 years ago, I thought what kinds of activity would me happy and healthier for the rest of my life. Before my aneurysm, I had a therapy dog, Dougal, who went with me to counsel children and families for years. So, then, he became MY therapy dog. I walked with him every day for two walks. By the end of 6 months it ended up being one mile a walk. This helped me physically and emotional because I often see different kinds of birds and enjoyed the wind and sun (or rain). Sometimes we actually saw deer, rabbits, skunks, porcupines or even a moose or a fox. I am very grateful that we live on a little acreage with interesting wildlife around. Walking is a good way to get exercise even if you are slow and awkward—you might get better over time.
My second thought was getting more organic vegetables in my body, but this very expensive. So I decided to start a garden. I needed lots of help but my husband was very helpful and understanding. He built 6 boxes that I could fill with good black soil the next year and then, I could sit around the edges to weed. Before my aneurysm, I had so much pain in my lower back that I always took pain killers every day. Having the boxes, made it easier. We also decided that we needed some fruit trees and shrubs, which filled me with happiness. This is a continual project every year because I want to try growing different vegetables and see which things will grow better here in the Sherwood Park area.
My third thought was getting more understanding what my physiotherapist had told me years earlier about my back problems--and that my back could straighten itself out when I went to yoga classes. In those years, before my aneurysm, I often went to one yoga class a week but it didn’t help very much. So, I decided to understand more about yoga and try to help myself by going into poses that could help me. I took a yoga teacher training course, which took a year, and this helped me immensely. Now, I go to yoga classes about 4 times a week and my back is a lot better—even through my gardening phase each year.
Also, during the winter, I try to go cross-country skiing because I realize that it is good for me physically. I am a person who doesn’t like to be outdoors when it is snowing and miserable. This means, I could only enjoy cross-country skiing when it is relatively warm and sunny. I didn’t go skiing last year because there wasn’t enough snow until it was close to spring. Besides walking with my dogs (we have Sophie as well as Dougal—who is old and slow), I should come up with another idea about being outside during winter. Perhaps others have better ideas. I realize that sunlight needs to be absorbs through the eyes to cut down the depression during the winter so I am open to other ideas.
Later on, I would look at what kinds of physical things which those us with stroke or related upsets would enjoy and write about them.
A Cappella Tribute Medley Song in Star Wars (John Williams Is The Man)
A Star Wars themed, four-part a cappella musical tribute set to cinematic themes from composer John Williams.
YouTube video (lip sync)......by Corey Vidal
Vocals (ALL singing)............by Moosebutter
Written and recorded...........by Moosebutter
Please support our careers, everyone's love of Star Wars, and the amazing work of John Williams by sharing this video.
A BIG thank you and ALL musical credit goes to the a cappella comedy group Moosebutter (from Provo, UT), who are not only the voices behind the song, but greatly assisted me in the making of this video and memorizing this brilliant track. Check out their website here: http://www.moosebutter.com/
Corey Vidal FULL INTERVIEW - The Surf [1 of 2]
(Nice interview about making A Cappella - SSTattler).
Old Strathcona Performing Arts Centre presents Kent Sangster’s Obsessions Octet
SUNDAY, JUN 17, 2012, 7:30 – 9:30PM
Location:Old Strathcona Performing Arts Centre (8426 Gateway Boulevard) Event Venue: Old Strathcona Description:Combining jazz master Kent Sangster and Edmonton’s finest jazz and classical musicians, this is a performance not to be missed! Cost: $20 in advance, $25 at the door, $15 Student Senior, $10 Fathers Day Special for Dads. Where to purchase tickets: Tix On The Square (9930 102 Ave NW) or www.tixonthesquare.ca. Tickets Phone:(780) 420-1757 Contact Name:Kent Sangster Contact Phone:(780) 935-2326 Contact Email:kent@kentsangster.com Link: www.kentsangster.com
In October, 2012, Edmonton’s own Obsessions Octet will be heading to New York for their international debut at Carnegie Hall. In a pre-Carnegie special performance, Kent Sangster’s Obsessions Octet will be performing at the Old Strathcona Performing Arts Centre (8426 Gateway Boulevard) on Sunday, June 17, 2012 at 7:30 pm. Combining jazz master Kent Sangster and Edmonton’s finest jazz and classical musicians, this is a performance not to be missed.
2007 Juno Award Nomination for Contemporary Jazz Album of the Year Western Canadian Music Award for Outstanding Jazz Recording.
Founded in 2005 by Kent Sangster, a Juno-nominated jazz saxophonist and composer, and his wife Joanna Ciapka- Sangster, a classically trained violinist, The Obsessions Octet is a fascinating experiment by several of Canada’s music luminaries. The Octet includes Chris Andrew (piano), Jamie Cooper (drums), Neda Yamach (violin), Rhonda Henshaw (viola), Ronda Metszies (cello), as well as Kent Sangster (sax) and Joanna Ciapka-Sangster (violin). Their repertoire has been described as an elegant mixture of classical, tango, and jazz - of the highest level.
Sangster is one of Canada’s premier jazz saxophonists, and is a multi-faceted musician of the highest regard. An accomplished composer and arranger, he is involved in a broad range of the music industry, locally, nationally and overseas.
“Obsessions Octet channels emotions into something more romantic. It’s not romance in a sugary, predictable style, but with a robust sound that supports a flood of musical communication.” ~ Roger Levesque, Edmonton Journal
Neuroscientists had once believed that the neurons that control movement send specific external information such as distance, direction and velocity to the muscles of the body. In a surprising new finding, however, researchers at Stanford University have proposed a new model that says motor neurons instead send basic rhythmic patterns down the spine to drive movement.
The neurons that control movement are not a predictable bunch. Scientists working to decode how such neurons convey information to muscles have been stymied when trying to establish a one-to-one relationship between a neuron’s behavior and factors such as muscle activity or movement velocity.
In an article published online June 3rd by the journal Nature, a team of electrical engineers and neuroscientists working at Stanford University propose a new theory of the brain activity behind arm movements. Their theory is a significant departure from existing understanding and helps to explain, in relatively simple and elegant terms, some of the more perplexing aspects of the activity of neurons in the motor cortex.
In their paper, electrical engineering Associate Professor Krishna Shenoy and post-doctoral researchers Mark Churchland, now a professor at Columbia, and John Cunningham of Cambridge University, now a professor at Washington University in Saint Louis, have shown that the brain activity controlling arm movement does not encode external spatial information – such as direction, distance, and speed – but is instead rhythmic in nature.
Understanding the Brain
Neuroscientists have long known that the neurons responsible for vision encode specific, external-world information – the parameters of sight. It had been theorized and widely suggested that motor cortex neurons function similarly, conveying specifics of movement such as direction, distance and speed, in the same way the visual cortex records color, intensity and form.
19th century mathematician Joseph Fourier showed that two rhythms could be summed to produce a third rhythm. Researchers at Stanford have shown that such mathematics are at play in the brain activity that produces arm movements.
“Visual neurons encode things in the world. They are a map, a representation,” said Churchland, who is first author of the paper. “It’s not a leap to imagine that neurons in the motor cortex should behave like neurons in the visual cortex, relating in a faithful way to external parameters, but things aren’t so concrete for movement.”
Scientists have disagreed about which movement parameters are being represented by individual neurons. They could not look at a particular neuron firing in the motor cortex and determine with confidence what information it was encoding.
“Many experiments have sought such lawfulness and yet none have found it. Our findings indicate an alternative principle is at play,” said co-first author Cunningham ...
Constraint therapy was not discovered by accident, but certainly there was an element of accident in the how it was shown to be effective.
Dr. Edward Taub surgically induced a stroke in monkeys and then he tied their good hand to see how much recovery they would get. Some animal rights activists let some of these monkeys free because they thought that tying the good hand was torture. The monkeys that were freed from the hand restraints didn’t get back as much function as the ones that were forced to use their stroke affected hand. What the animal rights activists saw as torture actually helped the monkeys recover the use of both hands.
In the first few weeks and months after stroke, many people don’t use their affected hand. They can use their unaffected hand to wheel the wheelchair and eat. There isn’t much therapy that encourages the use of the affected arm and hand.
In the first few days and even weeks after stroke, many stroke survivors spend much of their time alone either resting, or sleeping. This according to Taub, results in “learned non-use” of the arm and hand. Edward Taub and his group restrain stroke survivors’ unaffected hand with a mitt. They ask stroke survivors to work with the therapist and use their affected hand for many hours a day to do normal functional tasks like turning pages, picking up pennies, or even eating and drinking.
Constraint therapy is one of the most successful therapies currently in use to regain upper extremity function, AND since 2001 constraint therapy has also been used in the treatment of aphasia.
Pulvermüller’s group in Germany were the first to suggest that withdrawal from communication (not talking), change of communication strategies (letting someone else talk, saying as little as possible) and use of compensatory strategies (communicating by writing words with a pad and pencil), adopted by many patients with poststroke aphasia could be viewed as forms of learned-non-use in patients with aphasia.
They suggest that constraint based principles could be used to help people communicate better. Not everyone calls it constraint therapy. Different work-groups call it:
constraint-induced language therapy
constraint-induced aphasia therapy
intensive language-action therapy
The constraint therapy aphasia research demonstrates that even many years post stroke, intensive aphasia therapy can help people with aphasia improve their communication skills.
However, speech scientists don’t know which of the various factors used in constraint therapy make the most difference: constraint, forced use, intensity, duration, or the communicative environment. More research is definitely warranted. Since there is not an animal model for aphasia, it has to be done with people!
Ask the Heart and Stroke Foundation and the Canadian Stroke Network what type of aphasia research they have funded, are funding, or might be funding.
Or, if you have aphasia and you don’t care which of these factors are most effective helping people regain their communication skills, the InterACT program at Dalhousie in Halifax offers intensive aphasia treatment.
ABSTRACT. Meinzer M, Rodriguez AD, Gonzalez Rothi LJ. First decade of research on constrained-induced treatment approaches for aphasia rehabilitation. Arch Phys Med Rehab 2012;93(1 Suppl 1):S35-45.
Approaches for treating poststroke language impairments (aphasia) based on constraint-induced (CI) principles were first introduced in 2001. CI principles as previously applied to upper extremity and locomotor retraining in stroke survivors were derived from basic neuroscience. They comprise forced- use of the affected modality, a gradual rebuilding of targeted functions using a highly intensive treatment protocol, administered in a behaviorally relevant context. CI-based approaches have stimulated considerable neurorehabilitation research interest in the past decade. The original CI aphasia treatment protocol was tailored to improve functional communication in chronic aphasia (ie, 6–12mo after stroke) and more recently, it has been adapted to treat language impairments in acute stroke survivors as well. Moreover, CI therapy applied to aphasia has been used as a model to assess language network plasticity in response to treatment using functional imaging techniques. In the following article, we review the first 10 years of behavioral and functional brain imaging research on CI-based approaches for aphasia rehabilitation.
by Audrey L. Holland, University of Pittsburgh
1991 Journal of Neurolinguistics, Volume 6, Number 2
Abstract
This paper describes the rational and the data base upon which pragmatic approaches to the treatment of aphasia are based. It illustrates pragmatic treatment by describing three types of language therapy utilizing different treatment approaches. Strengths and weaknesses of pragmatic approaches are discussed. The paper concludes by suggesting that pragmatic treatment should be used in conjunction with other approaches more explicitly focused upon the language deficits exhibited by aphasic patients.
by Michaela M. Pinter, Michael Brainin
Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems
November 2011
Abstract
Stroke is a leading cause of disability and therefore rehabilitation is a major part of patient care. Most interventions do not target aged patient but there is unequivocal evidence to promote rehabilitation in multidisciplinary stroke units or integrated care of a multidisciplinary team in the community. Most research has focused on the effect of interventions on recovery in different forms of impairment and disability. The most promising options for motor recovery of the arm include constraint-induced movement therapy and robotic-assisted strategies. Interventions to improve postural stability and gait include fitness training, high-intensity therapy, and repetitive-task training. However, information about the clinical effect of various strategies of cognitive rehabilitation and strategies for aphasia and dysarthria is scarce. Several large trials of rehabilitation practice are underway to test these interventions in the elderly, either alone or in combination with early mobilisation, cardiorespiratory fitness training and physical exercise.
Constraint-Induced Movement Therapy: A New Family of Techniques with Broad Application to Physical Rehabilitation--A Clinical Review
Edward Taub, PhD; Gitendra Uswatte, MA; Rama Pidikiti, MD
Physical Medicine and Rehabilitation Service, Birmingham Department of Veterans Affairs Medical Center, Birmingham, AL 35233; Department of Psychology, University of Alabama at Birmingham, Birmingham, AL 35294-1170
Abstract -- A new family of rehabilitation techniques, termed Constraint-Induced Movement Therapy or CI Therapy, has been developed that controlled experiments have shown is effective in producing large improvements in limb use in the real-world environment after cerebrovascular accident (CVA). The signature therapy involves constraining movements of the less-affected arm with a sling for 90% of waking hours for 2 weeks, while intensively training use of the more-affected arm. The common therapeutic factor in all CI Therapy techniques would appear to be inducing concentrated, repetitive practice of use of the more-affected limb. A number of neuroimaging and transcranial magnetic stimulation studies have shown that the massed practice of CI Therapy produces a massive use-dependent cortical reorganization that increases the area of cortex involved in the innervation of movement of the more-affected limb. The CI Therapy approach has been used successfully to date for the upper limb of patients with chronic and subacute CVA and patients with chronic traumatic brain injury and for the lower limb of patients with CVA, incomplete spinal cord injury, and fractured hip. The approach has recently been extended to focal hand dystonia of musicians and possibly phantom limb pain.
Stem cells are biological cells found in all multicellular organisms, that can divide (through mitosis) and differentiate into diverse specialized cell types and can self-renew to produce more stem cells. In mammals, there are two broad types of stem cells: embryonic stem cells, which are isolated from the inner cell mass of blastocysts, and adult stem cells, which are found in various tissues. In adult organisms, stem cells and progenitor cells act as a repair system for the body, replenishing adult tissues. In a developing embryo, stem cells can differentiate into all the specialized cells (these are called pluripotent cells), but also maintain the normal turnover of regenerative organs, such as blood, skin, or intestinal tissues. There are three sources of autologous adult stem cells: 1) Bone marrow, which requires extraction by harvesting, that is, drilling into bone (typically the femur or iliac crest), 2) Adipose tissue (lipid cells), which requires extraction by liposuction, and 3) Blood, which requires extraction through pheresis, wherein blood is drawn from the donor (similar to a blood donation), passed through a machine that extracts the stem cells and returns other portions of the blood to the donor. Stem cells can also be taken from umbilical cord blood. Of all stem cell types, autologous harvesting involves the least risk. By definition, autologous cells are obtained from one's own body, just as one may bank his or her own blood for elective surgical procedures. Highly plastic adult stem cells are routinely used in medical therapies, for example bone marrow transplantation. Stem cells can now be artificially grown and transformed (differentiated) into specialized cell types with characteristics consistent with cells of various tissues such as muscles or nerves through cell culture. Embryonic cell lines and autologous embryonic stem cells generated through therapeutic cloning have also been proposed as promising candidates for future therapies. Research into stem cells grew out of findings by Ernest A. McCulloch and James E. Till at the University of Toronto in the 1960s. .... --->> See the full article Stem Cell from Wikipedia, the free encyclopedia.
Stroke: Spotlight on Stem Cell Research
Stem Cell Therapy for Stroke - Gary Steinberg, Stanford University
Gary Steinberg, M.D., Ph.D., spoke at the "Spotlight on Disease Team Awards: Sub-Cortical Stroke," an educational event presented at the CIRM Governing Board meeting on August 19, 2010. Steinberg is the principle investigator for the CIRM Stroke Disease Team. He is also the director of the Stanford Institute for Neuro-Innovation & Translational Neurosciences and is the chair of Department of Neurosurgery at Stanford University's School of Medicine.
The CIRM-hosted event was presented in Palo Alto, California at Stanford University.
Stem Cell Therapy for Stroke
Millions of stem cells derived from the bone marrow of healthy adult donors have been implanted in the brains of two stroke survivors at UPMC, as part of a two-site trial to determine whether bone marrow stem cells injected into the brain have therapeutic value in the healing of stroke lesions.
The researchers are seeking participants between the ages of 18 and 75 who have had an ischemic stroke between six months and three years before study entry.
Stem Cells Hold Hope For Stroke Cure
Adelaide University is using the courage of a stroke victim in its bid to find a cure.
Stem cells are cells found inside the body which may develop into one or more kinds of cells. Stem cells have been given special attention and importance by medical experts and researchers since these show great potency in treating or curing a variety of conditions and diseases such as Parkinson's Disease, Alzheimer's Disease, stroke, arthritis, burns, spinal cord injury and birth defects. Stem cells can then self-replicate or develop into more differentiated cell types....
Stem Cell Research: Ethical or Immoral?
My research video argument for my writing class.
Just a minor FYI: This was for a class. I did not ever intend for this video to reach more than a couple of views by my teacher and maybe a few classmates. Now that it is at 7k+ views I feel as though I should state that this video was meant to be informative, not rage inducing. I created this video in early 2010, therefore this video (I forget what all is in it, I haven't viewed it in a while) maybe be quite outdated. Thank you for viewing my project.
